Healthcare Provider Details

I. General information

NPI: 1609734698
Provider Name (Legal Business Name): MS. KOURTENEY ADRIANNA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 IRIS LN
BALDWIN NY
11510-5015
US

IV. Provider business mailing address

964 IRIS LN
BALDWIN NY
11510-5015
US

V. Phone/Fax

Practice location:
  • Phone: 917-421-6309
  • Fax:
Mailing address:
  • Phone: 917-421-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: